Left retroperitoneal aortic aneurysm repair in patients unsuitable for endovascular treatment

This study aims to evaluate the contemporary outcome of left open retroperitoneal (RP) abdominal aortic surgery over a 7-year time period in patients with difficult anatomy unsuitable for endovascular aneurysm repair (EVAR).

Eighty-four consecutive patients unsuitable for EVAR/FEVAR underwent left RP open aortic surgery. Of these, 44 (52%) required an infrarenal cross-clamp, 17 (20%) a suprarenal cross-clamp and 15 (18%) a supracoeliac cross-clamp. Eight (10%) were thoracoabdominal aneurysms.

There were four mortalities within 30 days (4.8%). Two occurred in patients with a supracoeliac cross-clamp, one in a suprarenal cross-clamp (total suprarenal mortality 10%) and one in an infrarenal cross-clamp. Four patients required prolonged ventilatory support (>10 days). Three patients (9%) from the suprarenal group developed post-operative renal dysfunction, one of these required permanent dialysis. Paralytic ileus occured in two patients (2%) and was secondary to ischaemia in both cases.

There will always remain a small group of patients best treated by open aortic surgery. By definition, these are complex, difficult cases and are decreasing in number. However, in vascular units regularly performing the RP approach, excellent results can be obtained. This series provides further evidence for centralization of vascular services.